[Can anemia be corrected in hemodialysis patients with thalassaemia minor?]

G Ital Nefrol. 2002 Sep-Oct;19(5):552-9.
[Article in Italian]

Abstract

Background: Anemia is an important negative prognostic factor for dialysis patients, whose correction reduces hospitalisation and mortality. Besides, the presence of the thalassaemia minor (Thal-m) in haemodialysed patients causes erythropoietin resistance and more serious anemia. The goal of this study is the correction of anemia (Hb >11 g/dL) in haemodialysed Thal-m patients.

Materials and methods: Multicentric, prospective and controlled 12-month study for the correction of anemia (up to values ranging from 11 to 12 g/dL) followed by a 12-month observation period. Ten Thal-m patients with inadequate anemia correction were studied after therapy with rHuEPO. Their age at the beginning of the study was 62.8+/-4 years while their dialytic age was 89+/-20 months.

Results: During the study we observed no changes in dry weight (p=NS), no increase in interdialytic weight (p=NS), cardiac frequency (p=NS), serum albumin (p=NS), serum aluminium (p=NS), PTH (p=NS), URR (p=NS), flow FAV (p=NS), TSAT (p=NS) and ferritin (p=NS) (maintained at their optimal values by means of intravenous therapy with trivalent iron. The hypotensive therapy (1.6 drug/patient/year) required no modifications during the 24-month study. The rHuEPO dose varied from 200.3+/-94.3 to 286.6+/-116.2, 317.0+/-119.5, 446.9+/-142.3, and 407.0+/-130.5 U/kg/wk (p < 0.0001 vs. initial value) (from the start to the 3rd, 6th, 9th and 12th month, respectively). The dose was subsequently reduced to 385.2+/-119.7 U/kg/wk at 15 months (p < 0.0001 vs. initial value) and remained unchanged until the end of the study. Simultaneously, the Hb values at corresponding times were 9.2+/-0.9, 9.4+/-1.1, 10.2+/-1.4, 10.9+/-1.5, 11.2+/-1.4 and 11.0+/-1.4 (p=0.002 vs. initial value). The correction of anemia produced progressive reduction in cardiac mass from 141+/-12 to 120+/-10 and 110+/-8 g/mq at the beginning, 12th month and 24th month (p < 0.0001), respectively. During the study the hospitalisation time was 4.3+/-1.2 day/patient/year during the 3-month run-in period, 3.4+/-1.4 day/patient/year during the first year, and 3.1+/-1.1 day/patient/year during the second year (p=0.098).

Conclusions: In conclusion we can say that the question of Thal-m in dialysis patients cannot be ignored or underestimated. The rHuEPO dosage in these patients must be reassessed (a dose of 450 U/kg/wk corresponding to approximately 60,000 units/week is acceptable and does not produce an increase in side effects if the correction is done gradually); moreover, other factors responsible for EPO-resistance must be eliminated (hyperthyroidism, aluminium intoxication, iron overloaded or deficiency).

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • English Abstract
  • Multicenter Study

MeSH terms

  • Aged
  • Aluminum / adverse effects
  • Aluminum / blood
  • Anemia / drug therapy*
  • Anemia / etiology
  • Body Weight / drug effects
  • Cardiomegaly / etiology
  • Cardiomegaly / prevention & control
  • Drug Resistance
  • Erythropoietin / administration & dosage
  • Erythropoietin / therapeutic use*
  • Female
  • Ferritins / blood
  • Hemodynamics / drug effects
  • Hospitalization / statistics & numerical data
  • Humans
  • Iron / blood
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy
  • Length of Stay
  • Male
  • Middle Aged
  • Organ Size / drug effects
  • Prospective Studies
  • Recombinant Proteins
  • Renal Dialysis* / adverse effects
  • Serum Albumin / analysis
  • Transferrin / analysis
  • beta-Thalassemia / blood
  • beta-Thalassemia / complications
  • beta-Thalassemia / drug therapy*

Substances

  • Recombinant Proteins
  • Serum Albumin
  • Transferrin
  • Erythropoietin
  • Ferritins
  • Aluminum
  • Iron